Columbia Slough Creek College
September 30th, 2017


Name *
Phone Number *
Phone Number
Are you registering for the full day, individual classes, or just the panel? *
Will you be joining us for lunch? *
Emergency Contact *
Emergency Contact
Emergency Contact Telephone *
Emergency Contact Telephone
First Time Creek College Participant?
Please describe any disabilities you may have that we can accommodate for.
Creek Colleges and the Native American Youth and Family Center (NAYA) are not responsible for damaged or stolen vehicles during the Columbia Slough project. I authorize and grant permission for a representative of The Creek College to treat minor injuries including scrapes, small cuts, splinters, and insect bites. I authorize and grant permission for a representative of The Creek College to obtain emergency medical care from any licensed physician or hospital and/or medical clinic should my child become ill or injured. I therefore freely and voluntarily execute this release with such knowledge, assume the risk of personal injury and/or property loss arising from or in any way connected with participation in any programs offered by The Creek Colleges and NAYA. I hereby release and discharge The Creek Colleges and NAYA and any and all agents of The Creek Colleges and NAYA from any liability, claim, cause of action, demand or damages from injury or damages of any kind to my child, myself or my property as a result of participation in the programs of The Creek College and NAYA. I grant permission and understand that photos and other images taken during this event could be used in print advertisements and other forms of media to promote The Creek College. I understand that should my child, or myself become a disruptive force during the educational program that the instructor may choose to release him/her from the program.
I have read and agreed to the terms and conditions of the general liability waiver. *